Sweeping changes in how physicians are paid for patient care are on the way. The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015, or MACRA, tossed out the Sustainable Growth Rate formula and ties reimbursement to quality measures.
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A Helpful Presentation
Because 2017 is the first performance year under the new laws, rheumatologists have numerous questions, concerns and opinions about how to adapt. To ease the transition to the new payment model, the 2016 ACR/ARHP Annual Meeting in Washington, D.C., will include a session called, Holy MACRA! How to Survive and Thrive in the New Era of MACRA, MIPS and APMs.
Speakers will include co-moderators William F. Harvey, MD, clinical director, Division of Rheumatology at Tufts Medical Center in Boston, and Douglas W. White, MD, a rheumatologist at Gundersen Health System
in LaCrosse, Wis. Harold D. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh, will round out the panel.
MACRA’s changes “are more impactful than even the Affordable Care Act. [MACRA] will fundamentally change how every rheumatologist is paid by Medicare,” says Dr. Harvey. He encourages meeting attendees to “hear the latest about this still-evolving program and understand how it will affect their practices.” In this session, attendees will learn “how to survive [under] the new pay-for-performance scheme and what to look for in an alternative payment model.”
MACRA will create a Quality Payment Program (QPP) to replace the SGR formula to determine Medicare payments. Providers will choose from one of two options: the Merit-Based Incentive Payment System (MIPS), in which providers will be scored on quality, resource use, clinical practice improvement and meaningful use of electronic health records (EHR); or eligible Alternative Payment Models (APMs), such as Accountable Care Organizations (ACOs).
Key Session Points & Objectives
Panelists will cover the following timely points:
- How physicians will be scored under MIPS;
- Who is excluded from the MIPS path and why;
- Quality measures that will apply to most rheumatologists;
- Strategies that will help rheumatologists avoid being assigned the highest costs within these programs; and
- APMs for rheumatologists who don’t want to transform their practices into ACOs.
The ACR raised concerns with the CMS that rheumatologists, particularly those in small and rural practices, need simple, transparent and tenable reporting requirements, and the flexibility of multiple options to transition smoothly to the first two years of the new payment system. In the final rule, released Oct. 14, the CMS did broaden exemptions from the program, which will help small practices that struggle with additional administrative work.
The ACR’s Rheumatology Informatics System for Effectiveness (RISE) Registry is one of the qualified clinical data registries (QCDRs) that MIPS-eligible rheumatologists and practice groups may use as intermediaries to submit quality-related data. Utilizing a reporting mechanism like RISE will allow rheumatology care providers to improve patient outcomes under MACRA. ACR policy and legislative staff will continue to examine MACRA rules to respond to members’ concerns, including problems with the Resource Use category of MIPS and potential barriers for rheumatologists to participate in APMs.
Sharing tips and best practices will help attendees maximize their future payments under MACRA, says Dr. White.
“I’d like this session to be a place where rheumatologists who have just started thinking about MACRA can interact with people who have been thinking about MACRA for months and even years,” he says. “One-on-one conversations will most help practicing rheumatologists move forward in this new world. We’ll work to enhance those networking opportunities at the session and at the ACR/ARHP Annual Meeting in general.”
In the past, physicians could choose whether they wanted to participate in such programs as the Physician Quality Reporting System or meaningful use, and balance incentives and penalties, says Dr. Harvey. “Now, with all those programs combined, there’s no way to see Medicare patients and avoid participation in all of them.”
Rheumatologists can ease many concerns about MACRA at this session, he adds.
“Though the benchmark for success will be known at the start of each year, it’s difficult to assess one’s practice and adapt as the year progresses. Physicians in small or solo practices are particularly vulnerable and in need of advice.”
When & Where?
Holy MACRA! How to Survive and Thrive in the Era of MACRA, MIPS and APMs will take place at 8:30 a.m. in Ballroom C on Sun., Nov. 13, at the ACR/ARHP Annual Meeting in Washington, D.C. The two-hour session will be available for viewing afterward via SessionSelect.
Susan Bernstein is a freelance medical journalist based in Atlanta.